Evidence-based guidelines for management of chronic kidney disease (CKD) have been available to practicing physicians since 2002. There is strong evidence that implementation of these guidelines by primary care physicians can delay CKD progression and reduce mortality. We will use an evidence-based multi-component implementation strategy (performance feedback, academic detailing, practice facilitation, and IT support) to help 32 primary care practices in 32 different communities, eight in each of four states, implement the CKD guidelines. We will then help those practices spread the guidelines to 64 additional practices (two new practices for each initial practice) within those same communities using local learning collaborative, inter-practice site visits, and less intensive facilitation. Implementation will be measured for each of ten key action steps outlined in the guidelines. These include: 1) diagnosis of CKD;2) diagnosis of anemia;3) avoidance of unsafe medications;4) use of indicated medications (ACEI or ARB);5) use of low dose aspirin;6) Measurement of HgbA1c;7) measurement of Hgb;8) BP <130/80;9) HgabA1c <7;and 10) LDL cholesterol <100. Assuming that all 96 practices implement the guidelines, this intervention can be expected to improve the care of approximately 20,000 patients will CKD. In the process, we will evaluate the impact of the implementation and diffusion strategies on the three components of the practice change model proposed by Solberg (priority for the change, overall change capacity, and change process content). Because we will be providing training and experience in evidence-based quality improvement methods to three additional practice-based research networks (LANet, WREN, MAFPRN), 96 practices, and 32 communities of practice, we hope to increase the likelihood that these groups will participate in subsequent quality improvement initiatives and in future implementation and diffusion research. PUBLIC HEALTH RELEVANCE: We propose to facilitate, using evidence-based strategies, implementation of chronic kidney disease guidelines in one practice in each of 32 different communities in four different states. We will then help each of those practices spread the guidelines to two additional practices within those same communities, reaching a total of 96 practices. Strategies will include performance feedback, academic detailing, practice facilitation, IT support, local learning collaborative, and inter-practice site visits.